Introduction

Treatment

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Optimum Imaging Strategies for Advanced Prostate Cancer

American Society of Clinical Oncology

Publication Date: January 27, 2020

Grading Table

Type		Benefit/harm		Evidence Quality		Strength of Recommendation
EB	Evidence-based	B	Benefits outweigh harms	H	High	Strong
CB	Consensus-based	H	Harms outweigh benefits	I	Intermediate	Moderate
IC	Informal consensus	B/H	Relative balance of benefits and harms	L	Low	Weak
IC	Informal consensus	U	Unknown	Ins	Insufficient	Weak

Abbreviations

bs: bone scintigraphy

CRPC: castration-resistant prostate cancer

ct: computerized tomography

mets: metastatic disease

mpmri: multiparametric magnetic resonance imaging

MRI: magnetic resonance imaging

NCCN: National Comprehensive Cancer Network

ngi: next generation imaging

PET: positron emission tomography

PSA: prostate-specific antigen

PSMA: prostate-specific membrane antigen

wb: whole body

Disclaimer

This pocket guide is derived from recommendations in the American Society of Clinical Oncology Guideline. This resource is a practice tool based on ASCO® practice guidelines and is not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines do not account for individual variation among patients. This pocket guide does not purport to suggest any particular course of medical treatment. Use of the practice guidelines and this resource are voluntary. The practice guidelines and additional information are available at www.asco.org/supportive-care-guidelines. Copyright © 2021 by American Society of Clinical Oncology. All rights reserved.

Optimum Imaging Strategies for Advanced Prostate Cancer

Introduction

Treatment

Newly Diagnosed Clinically High-Risk/Very High-Risk Localized Prostate Cancer

Conventional imaging negative

Conventional imaging suspicious/equivocal

Rising PSA after prostatectomy and negative conventional imaging (either initial PSA undetectable with subsequent rise or PSA never nadirs to undetectable)

Rising PSA after radiotherapy and negative conventional imaging

Metastatic prostate cancer at initial diagnosis or after initial treatment, hormone sensitive

Non-metastatic CRPC (nmCRCP)

Metastatic CRPC

PSA progression

Radiographic progression on conventional imaging

Figure 1. Imaging Algorithm for High/Very High-Risk Disease at Initial Presentation (per National Comprehensive Cancer Network [NCCN])

Figure 2. Imaging Algorithm for Patients with Rising Prostate-Specific Antigen (PSA) After Local Treatment

Grading Table

Abbreviations

Disclaimer